Barriers and facilitators to participating in cardiac rehabilitation and physical activity: A cross-sectional survey

There is a lack of research into green exercise which investigates and compares motivational drivers between the different types of outdoor activities. The current paper addressed this gap by classifying and comparing three types of green exercise: (i) Recreational physical activity, (ii) competitive sport, and (iii) outdoor adventure sport. Using a mixed methodological approach, the present study investigated the motivations for adhering to green exercise and directly compared the differences between these three forms of green exercise. Online questionnaires and face-to-face interviews were used to collect data. The results demonstrated that within all types of green exercise, enjoyment was the greatest motivator. Based on analysis of the qualitative materials, extrinsic motivators such as the environment, family, and friends were highlighted as key factors in beginning and continuing their activity. However, intrinsic motivators were also emphasised as more important in adherence to green exercise. Furthermore, as seen in other research, numerous psychological benefits were reported over time. The results of the study may act as a starting point in understanding how we may increase public engagement in green exercise by prompting participants to select a form of green exercise that best suits them based on their motivational profile.

Green exercise studies have tended to use walking as a modality of exercise to establish benefits to mental health. Whether green exercise benefits translate into different forms of green exercise has been deemed an important research gap. A mixed-methods study design was used to compare psychological responses between two forms of green exercise; golf and walking. A total of 20 participants (10 in each group), with a range of ages and experience were recruited to take part in the study. Participants in the walking condition exhibited significantly greater levels of dissociative cognitions than golf condition participants. Consequently, only the walking condition significantly improved in a directed attention test. Results from the Exercise-Induced Feeling Inventory questionnaire found the walking condition demonstrated increases in all four subscales, whereas the golf condition showed no significant improvements. Based on the findings from the qualitative analysis, distinct differences were seen with regards to the perception of the environment. Participants in the golf condition noted natural elements as obstacles to effective performance, whereas the walking group noted natural stimuli as evoking positive feelings. In agreement with the Attention Restoration Theory, the current study demonstrates that the benefits of green exercise are somewhat reduced when greater levels of directed attention towards the activity are exhibited during green exercise.

Individuals living in rural areas are more likely to experience cardiovascular diseases (CVD) and have increased barriers to regular physical activity in comparison to those in urban areas. This systematic review aimed to understand the types and effects of home-based connected health technologies, used by individuals living in rural areas with CVD. The inclusion criteria included technology deployed at the participant’s home and could be an mHealth (smart device, fitness tracker or app) or telehealth intervention. Nine electronic databases were searched across the date range January 1990–June 2021. A total of 207 full texts were screened, of which five studies were included, consisting of 603 participants. Of the five studies, four used a telehealth intervention and one used a form of wearable technology. All interventions which used a form of telehealth found a reduction in overall healthcare utilisation, and one study found improvements in CVD risk factors. Acceptability of the technologies was mixed, in some studies barriers and challenges were cited. Based on the findings, there is great potential for implementing connected health technologies, but due to the low number of studies which met the inclusion criteria, further research is required within rural areas for those living with cardiovascular disease.

Background: Wrist-worn devices that incorporate photoplethysmography (PPG) sensing represent an exciting means of measuring heart rate (HR). A number of studies have evaluated the accuracy of HR measurements produced by these devices in controlled laboratory environments. However, it is also important to establish the accuracy of measurements produced by these devices outside the laboratory, in real-world, consumer use conditions. Objective: This study sought to examine the accuracy of HR measurements produced by the Withings ScanWatch during free-living activities. Methods: A sample of convenience of 7 participants volunteered (3 male and 4 female; mean age 64, SD 10 years; mean height 164, SD 4 cm; mean weight 77, SD 16 kg) to take part in this real-world validation study. Participants were instructed to wear the ScanWatch for a 12-hour period on their nondominant wrist as they went about their day-to-day activities. A Polar H10 heart rate sensor was used as the criterion measure of HR. Participants used a study diary to document activities undertaken during the 12-hour study period. These activities were classified according to the 11 following domains: desk work, eat or drink, exercise, gardening, household activities, self-care, shopping, sitting, sleep, travel, and walking. Validity was assessed using the Bland-Altman analysis, concordance correlation coefficient (CCC), and mean absolute percentage error (MAPE). Results: Across all activity domains, the ScanWatch measured HR with MAPE values <10%, except for the shopping activity domain (MAPE=10.8%). The activity domains that were more sedentary in nature (eg, desk work, eat or drink, and sitting) produced the most accurate HR measurements with a small mean bias and MAPE values <5%. Moderate to strong correlations (CCC=0.526-0.783) were observed between devices for all activity domains, except during the walking activity domain, which demonstrated a weak correlation (CCC=0.164) between devices. Conclusions: The results of this study show that the ScanWatch measures HR with a degree of accuracy that is acceptable for general consumer use; however, it would not be suitable in circumstances where more accurate measurements of HR are required, such as in health care or in clinical trials. Overall, the ScanWatch was less accurate at measuring HR during ambulatory activities (eg, walking, gardening, and household activities) compared to more sedentary activities (eg, desk work, eat or drink, and sitting). Further larger-scale studies examining this device in different populations and during different activities are required.

Previous research has shown individuals living with type 2 diabetes are more likely to experience depression, anxiety and reduced quality of life (QoL) in comparison to those without the disease. Physical activity has been highlighted as an important factor in improving physiological and psychological parameters in this population. Previous systematic reviews have found mixed results regarding the effects of exercise on psychological problems. Green exercise is an emerging research area with mounting evidence demonstrating positive effects on mental health. Objectives of the current review investigated whether conducting physical activity in outdoor environments had any effect on psychological problems in individuals with type 2 diabetes. Methods such as PubMed, Medline, PsycINFO, Scopus, Cochrane library, CINAHL, SPORTDiscus and Google Scholar databases were searched. The databases were searched for articles which used an outdoor exercise intervention and investigated psychological problems in individuals with type 2 diabetes. Results from the 1467 retrieved articles, 4 studies were included in the systematic review, consisting of 231 participants. All four studies investigated QoL, one study looked at depression and one investigated general wellbeing. Mixed results were found regarding QoL, no significant effect was found for depression. However, general wellbeing was improved. Due to the limited number of studies eligible for inclusion and the heterogeneity of outcome measures, it was difficult to draw firm conclusions. This systematic review acts as a starting point for future investigations into the use of green exercise in improving the mental health of individuals living with type 2 diabetes. Registration: PROSPERO: CRD42018088212